Cancer begins, for reasons not yet fully understood, when the cells in our body grow and divide abnormally. A cluster of abnormal cells forms a tumour, which then grows and spreads; it is malignant and is called cancer.
Secondary (metastatic cancer) liver cancer is cancer that has spread to the liver from another part of the body. It is the commonest liver cancer in the UK. Cells from the primary cancer escape into the bloodstream to reach the liver. The liver is a likely place for secondary cancer because it acts as a filter and all the blood in the body passes through it. It also provides a favourable environment for cancer cells to grow.
In a healthy person up to three quarters of the liver can be removed and the remainder will regrow.
Each day, 40 people somewhere in the UK will be diagnosed with secondary liver cancer
Q: Are patients with secondary cancer of the liver more likely to live longer today than they were 15 years ago?
A: About 20 years ago a diagnosis of liver secondaries from a primary bowel cancer (liver metastases) meant almost certain death within 3 to 4 years and virtually no-one lived for 5 years. Up to 15 years ago liver surgery alone salvaged 37% at 5 years. Today using a combination of chemotherapy followed by liver surgery 46% are alive 5 years after the diagnosis of liver metastases.
Q: Can patients get the best treatment for liver secondaries in the NHS?
A: There is still a postcode lottery related to funding, especially for effective chemotherapy. The best chemotherapy treatment includes drugs like oxaliplatin, cituximab, avastin etc. Some of these are available on the NHS provided the patient’s care has been discussed in an MDT (Multidisciplinary Team) meeting and the liver secondaries are deemed operable. Unfortunately in large parts of the country a liver surgeon is not involved in the decision-making process regarding operability.
Q: How can patients be sure they are getting the best treatment for cancer?
A: As consultants specialise, patients get a better opinion, provided several specialists are involved. Patients can request that their case be discussed at a properly constituted MDT and that their scans be shown to specialist liver surgeons so that they can get a proper opinion regarding operability. Patients can also research the web and have their scans reviewed by another MDT if they remain in doubt.
Q: Have support services improved for patients with liver cancer?
A: Support networks are improving all the time. The Liver Cancer Surgery Appeal raises money for equipment and research. The appeal has been involved in the production of information leaflets and newsletters. In Surrey the Regional Hepatobiliary Unit is based at Guildford and this unit has 2 dedicated specialist nurses available to counsel patients and advise them as to the best course of action.